Two issues limit the overall effectiveness of vaccination strategies in transplant recipients. First, transplant recipients may have declining antibody levels and diminished antibody responses to previous vaccine antigens once they become severely immunosuppressed (loss of previous immunity). Secondly, available evidence suggests that transplant recipients have diminished, although not absent, responsiveness to immunization (reduced vaccine efficacy). This is best demonstrated in kidney, liver and heart recipients after immunization with the pneumococcal vaccine.
Solid organ transplant recipients require periodic assessment of immunization status for vaccine-preventable illnesses, beginning during the pre-transplantation evaluation. Routine immunizations are administered or updated as long as possible before the transplant to allow for the development of immunity; these vaccinations include the hepatitis B series, hepatitis A, pneumococcal, yearly influenza, and tetanus-diphtheria. For VZV-seronegative transplant candidates, immunization with the varicella vaccine should be considered. In general, live attenuated virus vaccines are contraindicated in severely immunosuppressed hosts because of the potential for viral reactivation. Also, household contacts of transplant recipients should not undergo immunization with live viruses because of the potential for secondary infections.
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